A COMPARATIVE ANALYSIS OF FREQUENCY AND PATTERNS OF OVARIAN TUMOURS AT A TERTIARY CARE HOSPITAL BETWEEN TWO DIFFERENT STUDY PERIODS ( )

Transcription

1 ORIGINAL ARTICLE A COMPARATIVE ANALYSIS OF FREQUENCY AND PATTERNS OF OVARIAN TUMOURS AT A TERTIARY CARE HOSPITAL BETWEEN TWO DIFFERENT STUDY PERIODS ( ) ABSTRACT Objective: This udy was conducted to inveigate the frequency and type of ovarian tumors among patients who underwent surgery for ovarian cy diagnosed on ultrasound and also to compare a change in pattern of type of tumors between 2002 and Study Design: Comparative,Observational udy. Setting & Duration: This udy was carried out in the department of obetrics and gynaecology Foundation University Medical College, Fauji Foundation hospital Rawalpindi that is a tertiary care hospital, from 1 June 2002 to 31 May 2003 (Study period 1, n=90) and from 1 November 2008 to 31 October 2009 (Study period 2, n=93). All the patients who had ovarian cys larger than five centimetres in size diagnosed on ultrasonography and planned for surgery were included in the udy. All the relevant details were entered in proformas. Hiopathology of excision biopsies was analysed. Results: The overall incidence of ovarian tumors was 7.1% and.% with a rate of malignancy 18% and.% in period 1 and 2 respectively which was atiically non significant (p>0.0). The mo common malignant tumour was serous cy adenocarcinoma during both udy periods. The mo common benign tumor was simple follicular cy 2% during udy period one and serous cy adenoma 23% during period 2. Conclusion: The frequency and patterns of ovarian tumors has remained unchanged between 2002 and Key Words: Ovarian cys, ovarian tumors, benign, malignant. This article may be cited as: Shoail I, Hayat Z, Saeed S. A comparative analysis of frequency and patterns of ovarian tumours at a tertiary care hospital between two different udy periods ( ). J Pograd Med In 2012; 26(2): INTRODUCTION exact incidence is not known but it ranks fourth commone cancer among females of Pakian and Ovarian carcinoma is the sixth commone 2 is notorious to present at an advanced age.asian female cancers and the fourth leading cause of countries and Japan have rates of 2-6. new cases 1 death due to cancers in women. In Pakian the 3 per 100,000 women per year. 1 Department of Obetrics and Gynaecology, Al-Nafees Medical College Islamabad - Pakian 2-3 Department of Obetrics and Gynaecology and Pathology, Foundation University Medical College, Fauji Foundation Hospital Rawalpindi - Pakian Address for Correspondence: Dr. Irum Sohail Professor and Head, Department of Obetrics and Gynaecology, Al-Nafees Medical College Islamabad-Pakian sohail_irum@yahoo.com Date Received: May13, 2011 Date Revised: January 6, 2012 Date Accepted: January 16, Irum Sohail, Zartaj Hayat, Sami Saeed Benign ovarian cys are the commone conituting about 90% of ovarian tumors. The re are of coelomic epithelial origin while germ cell and sex cord romal tumors are much less frequent. Whatever the origin, ovarian tumors are generally difficult to detect until they are of advanced age or are large in size. This is primarily due to the reason that either the symptoms are vague or mo of these are asymptomatic therefore they manife over a time period due to no definite screening program. It is very important to determine the hiological pattern of ovarian tumors because the p r o g n o s i s d e p e n d s u p o n t h e d e g r e e o f differentiation. Similarly the age and the laterality of tumors are important in categorizing them in malignant tumors. 196

2 In this udy we have tried to find out the gynecological admissions in udy period 1 while frequency of malignant ovarian tumors among in the udy period two we had 93 patients out of the patients reporting with ovarian cys more than total of 1711 admissions. In period 1 frequency of five centimeters (cm) over a span of two different ovarian tumors was 7.1% and was reduced to.% years. We selected two different periods as to see in period 2. The benign tumors were seen in 78.8 if there was a change in the pattern or type of % and malignant in 18.8 % of the patients while ovarian malignancy in patients reporting to us. 2.2% had borderline tumors in period 1. In comparison in period 2, 70.9 % of tumors were METHODOLOGY benign while 27.9 % were malignant and 1.07% had borderline tumors (Figure I). (When we This udy was conducted from 1 June applied the Fischer exact te and analyzed there 2002 to 31 May 2003 (udy period 1) and from was no atiical significant difference in reporting 1 November 2008 to 31 October 2009 in (udy of the ovarian tumors in two udy periods as p- period 2). We recruited all the patients who value was 0.371). A total of three (1.6%) reported to the gynaecology outpatient department borderline cases were seen, two in the period 1 (OPD) of Fauji Foundation Hospital (FFH) while only one case reported in the period 2 (Table Rawalpindi with an ovarian cy larger than five 1). When we see the whole group of the patients cm diagnosed on ultrasonography. The patients mo of the women with benign and malignant who didn't undergo surgery or were treated ovarian tumors (2% and 1%) respectively were + conservatively were excluded from the udy. In in the age group of 0. Similarly three (1.6%) addition the patients whose hiopathology reports patients of borderline category also belonged to were lo were also excluded from udy. The this age group (Table 2). When the two years were udy was approved by the ethical committee of compared for the frequency of malignancy the hospital and the patients who agreed to according to age group maximum number of participate were asked to sign a consent form. The patients belonged to > 0 year age group (mean data including a detailed hiory, clinical age in year I is.08 years and in year II is 2.79 examination, ultrasonography findings and years) and frequency was 76% and 3.8% hiopathology report of excision biopsies (after respectively for each udy period. surgery) was entered into proformas for further When the relationship of parity with the atiical analysis using SPSS version 1. Fischer ovarian tumors was analyzed, it was observed that exact te was applied for atiical analysis. benign tumors were maximum (37%) in the group having 3- children while malignant tumors were RESULTS common in group having two or less children After fulfilling the exclusion criteria, we (8.7%) & borderline tumors were only observed in were left with 90 patients out of total of 1267 the group having 3- children (Table 3). Table 1: Comparison of frequency of ovarian tumors in year 1 and 2. (n=183) Category Period 1 Period 2 Total Benign 71 (78.8%) 66 (70.9%) 137 (7.8%) Borderline 2 (2.2%) 1 (1.07%) 3 (1.6%) Malignant 17 (18.8%) 26 (27.9%) 3 (23.%) Total Fischer Exact= Table 2: Diribution according to age groups (n=183) Age group Benign Borderline Malignant < > Total 137(7%) 3(1.6) 3(23.%) Total 23(12.%) 3(29%) 107(8.%)

3 Table 3: Diribution according to Parity (n=183) Parity Benign Borderline Malignant (3%) 0 16 (37%) 3-0 (37%) 3 (100%) 1 (33%) (28%) 0 13 (30%) Total 137 (100%) 3 (100%) 3 (100%) Total 6 (3%) 67 (37%) 2 (28%) 183 (100%) The analysis of individual type of ovarian We had mo of our patients belonging to cy was also done. It was observed that mo > 0 year age group (with 3.89 years as common benign tumor in period 1 was simple combined mean age of both years). This matches follicular cys 2% (23) followed by serous cy with the udy done in Japan that showed mean adenoma 1% (1) and mucinous cy adenoma age of group having benign ovarian cy as 8 13% (12). In period 2 commone benign tumor years while for malignant it is 61 years. Peak was serous cy adenoma 23% (22) followed by incidence of ovarian tumors is between 21 to 0 corpus luteal cy and benign cyic teratoma in 10 years. However malignant cases are moly seen 10% each. 11 in elderly. In our udy too, the malignant tumors In period1 the commone malignant tumor were seen in elderly thus making these women was serous cy adenocarcinoma.% () followed prone to malignancy. by mucinous cy adenocarcinoma, granulosa cell Repeated imulation of the ovarian tumor, endometriod carcinoma and Sertoli Leydig epithelium has been suspected to be a predisposing cell 2% (2) each. In period 2, serous cy 1 2 factor for malignant transformation. Thus adenocarcinoma was again the commone 7.6% increased parity will have a protective effect on (8) followed by endometriod carcinoma 6% (6) the development of ovarian tumors. This was and dysgerminoma % (). evident in our udy too, as women having parity DISCUSSION of 0-2 had maximum number of malignant tumors. Benign tumors were common in women who had Our hospital is a tertiary care hospital parity of 3-.This is in contra to a local udy where patients are referred from the adjoining and that showed that an increased parity in our country 13 far flung areas. As it is a free hospital for exregional udy S Kayaha et al also had 8.9% of was not protective for ovarian malignancy. In a armed forces personnel, a variety of gynaethe ovarian tumors belonging to the low parity cological diseases including malignancies is frequently seen. We had done this udy over a women. period of two separate years to see any difference Among hiological typing of tumors in in frequency of ovarian tumors or their patterns. our udy, the mo common benign tumors were The frequency of ovarian tumors in udy follicular cys 2% followed by serous cy period 1 was 7.1% while during udy period 2 it adenoma 1% and mucinous cy adenoma 13%. was.%. This was quite high when compared These findings are similar to udy done by with udy done in Peshawar where it was Tayyiba et al in Lahore in 2009 where follicular 1.2%.The frequency was 16.7% in a teaching and luteal cys were 32% followed by serous cy 1 hospital in Nepal. Among these tumors 78% adenoma in 23% of cases. In udy period 2 again were benign and 18% were malignant in period 1 serous cy adenoma was the commone tumor in while in period 2, 70% were benign and 27% were 23% of cases followed by luteal cys and benign malignant. These figures were quite similar to the cyic teratoma in 10% each. The udy done in 1 6 data from the We. When compared with local India also showed similar frequency as follicular data the frequency of benign ovarian cys was and luteal cys being 80% followed by surface %, 9% and 89.7%. Similarly the frequency of epithelial tumors 8.8% and germ cell tumors 7 8 malignant ovarian tumors was 22%, 0% and 23.9%. The frequency of different ovarian tumors 10% respectively. The data from South Ea in Peshawar was also same where epithelial Asia shows that 90.% of ovarian cys were tumors were followed by germ cell tumors. benign while 9.% were malignant. Another udy The overall malignant pattern showed that conducted in Nepal showed a malignancy rate of mo common tumor in our udy was serous cy %. A udy carried out by Phillip et al had adenocarcinoma in 8.6% of cases followed by approximately similar results. endometriod carcinoma in 6% and dysgerminoma 198

4 6 If we compare our data to that in USA serous cyadenocarcinoma was the commone tumor 3% while endometriod adenocarcinoma was seen in 11.1% of cases. Similarly udy done 18 in Japan also showed serous cyadenocarcinoma a s t h e c o m m o n e s t 8 % w h i l e m u c i n o u s adenocarcinoma was the second commone 21% and endometriod was 8.2%. Regarding the borderline ovarian tumors, three (1.6%) of our patients fall in this category, two in year 1 and one patient in year 2. All three were more than 0 years old and parity group was 3-. In general, patients with borderline ovarian are younger than those with invasive carcinoma 19 and the risk decreases with increasing parity. None of our patients who were in para group 6 or more had borderline ovarian tumors. Genardy reviewed 1 patients and peak age was during 20 reproductive years. In a udy by Chamber et al, 21 the mean age was 0. years. Borderline ovarian tumors conitute 10-1% of epithelial ovarian tumors; more than 96% of which are either of 2 2 serous or mucinous origin. Regarding the hiologic subtypes in our udy, out of three, two were borderline mucinous and one was borderline serous. Overall the pattern of hiological types of ovarian tumors is almo the same in our udy as in all the other udies done worldwide reporting epithelial tumors being the commone. However in our udy the frequency of ovarian malignancy has not increased between years Similarly the type of ovarian tumors has also remained the same. CONCLUSION In udy period 1 and 2, the frequency of ovarian tumors was 7.1% and.% respectively among all gynecological admissions. The malignancy was reported in 18% and 27% of the cases who had ovarian cy larger then cm. However the frequency of ovarian tumors did not in %. This is the same as in a udy done in 16 Rawalpindi in 200 that showed serous cya- denocarcinoma as the commone, being 6.7% while endometriod carcinoma was seen in.7% of cases and dysgerminoma in 6.06%. Similarly the pattern of malignancy by Gill et al has shown serous cy adenocarcinoma being the commone 8 33% of all malignant ovarian tumors. If we see the African udies then in Nigeria the commone 17 malignant tumor was Granulosa cell tumor 20%, while in our udy two women each in both years had it. The udy in Peshawar showed granulosa cell tumor as the commone 28%. Studies done in 9 N e p a l f r o m s h o w e d s e r o u s adenocarcinoma as the commone tumor 6.2%. differ in these two udy periods. Similarly the pattern of types of ovarian tumors was almo the same in these patients. Grant Support, Financial Disclosure and Conflict of Intere None Declared REFERENCES 1. Tortolerol, Mitchell FM, Rhodes HE. Epidemiology and screening of ovarian cancer. Obet Gynecol Clin North Am 199;21: Parveen S, Ilyas N, Asghar S. Patterns of care for ovarian cancer. Patients at Initute of Nuclear Medicine and Oncology (INMOL) Lahore. Speciali J Pak Med Sci 1999;1: Murad A. Ovulation induction and ovarian tumors the debate continues. J Pak Med Assoc 1998;8: Yasmin S, Yasmin A, Asif M. Frequency of benign and malignant ovarian tumors in a tertiary care hospital. J Pograd Med In 2006;20: Kayaha S. Study of ovarian tumors in Nepal Medical College Teaching Hospital. Nepal Med Coll J 2009;11: Koonings PP, Campbell K, Mishell DR Jr, Grimes DA. Relative frequency of primary ovarian neoplasms: a 10 year review. Obet Gynecol 1989;7: Fatima Z. The pattern of ovarian masses. Ann King Edward Med Uni 2006;12: Ahmed Z, Kayani N, Hassan SH, Muzaffar S, Gill MS. Hiological pattern of ovarian neoplasms. J Pak Med Assoc 2000;0: Jha R, Karki S. Hiologic pattern of ovarian yumors and their age diribution. Nepal Med Coll J 2008;10: Pilli GS, Sunecta KP, Dhaded AV, Yenni VV. Ovarian tumors a udy of 282 cases. J Indian Med Assoc 2002;100: Di Bonito L, Patriarca S, Delendi M, Alberico S. Ovarian tumors: anatomohiopathological contribution to their interpretation. Eur J Gynecol Oncol 1988;9: Briow RE, Karlan BY. Ovulation induction, infertility and ovarian cancers risk. Fertil Steril 1996;66: Zahra F. Parity and epithelial ovarian tumors. Pak J Med Health Sci 2007;1: Wasim T, Siddiq S, Majrooh A. Comparison of 199

5 clinical presentation of benign and malignant Association of reproductive factors, oral ovarian tumors. J Pak Med Assoc 2009;9:18- contraceptive use and selected lifeyle factors 21. with the risk of ovarian borderline tumors: a Danish case- control udy. Cancer Causes 1. Gupta N, Bisht D, Agarwal AK, Sharma VK. Retrospective and prospective udy of ovarian Control 2006;17: tumours and tumour-like lesions. Indian J 20. Genadry R, Poliakoff S, Rotmensch J, Pathol Microbiol 2007;0:2-7. Rosenshein NB, Parmley TH, Woodruff JD. 16. Ahmed M, Masood T, Afzal S. Clinicopatho- Primary, papillary peritoneal neoplasia. Obet logical udy of 762 ovarian neoplasms at Gynecol 1981;8:730-. Army Medical College Rawalpindi. Pak J 21. Chambers JT, Merino MJ, Kohorn EL, Pathol 200;1:17-2. Schwartz PE. Borderline ovarian tumors. Am J 17. Bobzom DN, Unuigbe JA. Types of ovarian Obet Gynecol 1988;19: tumors seen in Benin-City, Nigeria. J Obet 22. Ahmed ASM, Lawton FG. Borderline ovarian Gynecol 1997;17:80-1. tumors: current concepts and management. Rev Gynecol Prenat Pract 200;: Inai K, Shimizu Y, Kawai K, Tokunaga M, Soda M, Mabuchi K, et al. A pathological udy of malignant and benign ovarian tumors among atomic bomb survivors--case Series report. J Radiat Res(Tokyo) 2006;7: Huusom LD, Frederiksen K, Høgdall EV, Glud E, Chriensen L, Høgdall CK, et al. CONTRIBUTORS IS conceived the idea and planned the udy. ZH & SS did the data collection and analyzed the udy. All the authors contributed significantly to the research that resulted in the submitted manuscript. 200